Angioedema
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Angioedema. Overview. Self-Limited, subcutaneous edema resulting from increased vascular permeability Dilation of venules and capillaries Different from urticaria Limited to the superficial dermis Generally resolves over 24-48 hours Mast Cell / Kinin related etiologies

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Angioedema

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Angioedema

Angioedema


Overview

Overview

  • Self-Limited, subcutaneous edema resulting from increased vascular permeability

    • Dilation of venules and capillaries

    • Different from urticaria

      • Limited to the superficial dermis

  • Generally resolves over 24-48 hours

  • Mast Cell / Kinin related etiologies

  • Involvement of the lips, pharynx and bowel common (potentially life-threatening)

  • Treated with CCS and H1/H2 blockers

    • FFP has been used in C1-Inh deficiency


Etiology

Etiology

  • Immunologic / IgE mediated

    • elicited by foods, additives, drugs, transfusions, insect bites and infection

      • Release of vasoactive mediators from mast cells

      • Urticaria and pruritis

  • Hereditary and Acquired (non-mast cell)

    • Bradykinin and complement-mediated increases in vasc perm.

    • ACE-I or NSAID


Ace inhibitors

Ace-Inhibitors

  • ACE (Kininase II) degrades bradykinin

    • Vasodilator

  • ACE-I results in inc levels bradykinin

    • Vasc B-2 rec’s for vasodilation, inc perm, inc NO

    • Not related to ACE-I induced cough

  • Pts with genetic deficiencies in bradykinin degradation could be at higher risk

  • 0.1-0.7% of patients tx with ACE-I

  • Intestinal edema may develop

    • Sudden onset abdom pain, vomiting and diarrhea


Ace i

ACE-I

  • 50% of cases occur within 1 week of tx

    • Others may occur years later

  • Class specific

  • ARB’s - have been linked to episodes of angioedema

    • 2 of 26 pts with ACE-I induced angioedema persisted with an ARB and resolved with its withdrawal

    • Switch with caution


Hereditary acquired

Hereditary/Acquired

  • Kinin-mediated angioedema that may be unmasked with use of ACE-I

  • C1-Inh deficiency (level or fx) - Inc BKinin

    • Normally fx to degrade C1 and prevent excessive complement activation

    • Dec levels of C1, C2, C4

    • Acquired- malignancy or auto-antibodies (older onset)


Summary

Summary

  • Angioedema is potentially life-threatening

  • Associated pruritis and hives points to anaphylaxis

  • Absence of pruritis and hives think ACE-I and/or C1-Inh deficiency

    • PMHx, FHx, Malignancy

  • Use caution when switching from an ACE-I to an ARB


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